Roupen Odabashian: Whole-Body MRI: A Comprehensive Approach to Cancer Screening with Growing Potential and Challenges

Roupen Odabashian posted on LinkedIn:

“Disclaimer: My name is Roupen, and I am an Oncologist I see cancer patients daily, Please note that this article reflects my personal ideas and thoughts, and they are not endorsed by any guidelines or by my employers.

I am advocating not just for whole-body MRI, but for any tool that aids in cancer screening and prevention, rather than focusing solely on cancer treatment in advanced stages. This perspective comes from the devastation I’ve experienced seeing young patients die from cancer.

Whole-Body MRI

Whole-body MRI (WB-MRI) is a technology we’re increasingly using to screen for cancers. Instead of focusing on a single body part, WB-MRI provides comprehensive coverage. While not yet approved by medical guidelines, there are efforts to popularize this approach, notably by figures like Kim Kardashian and various YouTube biohackers supporting startups in this field like Bryan Johnson

Furthermore, there are companies that are working to make the technology accessible to the general population like Prenuvo.

I adhere to the guidelines to treat my patients and assist them daily. However, as a human being, I am deeply affected when I see young patients diagnosed with cancer. Current guidelines recommend cancer screening at specific ages, or younger for those with certain risk factors for colon, breast, or pancreatic cancer.

Yet, I encounter many patients in their 30s with breast cancer or in their 40s with prostate cancer, often without any risk factors. These aggressive cancers in young individuals are particularly devastating. There is even a growing body of evidence supporting that cancer incidence is increasing in younger populations.

I often wonder if earlier screening could have made a difference. Despite the remarkable results achieved with many drugs, we still haven’t found a cure for cancer. This makes me question why we don’t prioritize cancer prevention over treatment.
Let’s discuss cancer prevention and the current spending on it in the U.S.

How much do we spend on prevention?

In 2022, U.S. healthcare spending reached $4.5 trillion. However, only 3.5% of that total budget was dedicated to preventive care, with just 1.3% allocated specifically for cancer screening. Doing the math, this means the U.S. spent approximately $58.5 billion on cancer screening that year.

In contrast, cancer treatment costs significantly more. As the numbers clearly show, we spend much more on treatment than on prevention. In simple terms, if you spend 4500 dollars on your health each month, you only spend 58 dollars on cancer prevention!

The following image shows explains the previous paragraph.

Before diving into the details, it’s crucial to discuss the positives and negatives of this technology. Please note that this is not an extensive review or a research study. It’s primarily based on my reading of the literature and may also reflect my personal opinions.

What are the current cancer screening tools?

Mammography is widely used for breast cancer screening, recommended for women aged 40 and older to detect early-stage tumors.

Colonoscopy is the standard for colorectal cancer screening, typically recommended starting at age 45, allowing for the detection and removal of polyps before they turn cancerous.

Pap smears and HPV testing are essential for cervical cancer screening, targeting women aged 21 to 65 to catch abnormal cells early.

Low-dose CT scans are used to screen for lung cancer, primarily in high-risk populations such as heavy smokers aged 50 to 80.

Prostate-specific antigen (PSA) testing helps detect prostate cancer in men, usually recommended for those over 50 or with a family history of the disease.

Lastly,skin examinations and dermoscopy are utilized to screen for melanoma and other skin cancers, especially in individuals with a high risk of skin cancer due to factors like fair skin or excessive sun exposure. Each tool is designed to catch cancer at an earlier stage, improving the chances of successful treatment.

Are more younger patients diagnosed with cancer?

There is evidence that more younger patients are being diagnosed with cancer. Recent studies have shown an increase in the incidence of several types of cancer among younger adults.

A review published in the British Journal of Cancer found that the incidence of colorectal, breast, kidney, pancreas, and uterine cancers is increasing in younger age groups, while the incidence of lung, laryngeal, and bladder cancers is decreasing. This trend has been observed in high-income countries.

Additionally, a study in Cancer Journal for Clinicians reported that overall cancer incidence increased in adolescents and young adults (AYAs) aged 15-39 years during the most recent decade (2007-2016). This increase was largely driven by thyroid cancer and several cancers linked to obesity, such as kidney and uterine cancers.

Furthermore, a study in JAMA Network Open analyzing data from 2010 to 2019 found that the age-standardized incidence rate of early-onset cancers increased overall, particularly for gastrointestinal cancers, which had the fastest-growing incidence rates among all early-onset cancer groups.

As you can see, the current guidelines do not address young cancer patients without risk factors who visit the clinic almost every day. Furthermore, there are many cancers that happen in young patient and we don’t have screening tools.

What do professional societies say about using Whole-Body MRI for Cancer screening in healthy individuals?

MD Anderson warns patients about being misled by MRI scans, as they can result in unnecessary investigations and studies.

The American College of Preventive Medicine also warns against obtaining whole-body MRI because there is no data suggesting that these studies will improve overall survival of patients.

Dana-Farber Cancer Institute also warns against whole-body MRI because of the lack of data.

As you can see from the links, all professional societies warn against whole-body MRI because we lack data on its effect on overall survival for the general population. We don’t have evidence on whether this tool is effective in detecting cancer early and how that might impact survival rates.

The absence of data doesn’t mean we should dismiss the investigation. Instead, it highlights the need for rigorous studies.

We need randomized clinical trials where one group of the study subjects undergoes whole-body MRI over time, and another does not. By comparing these groups, we can determine if early cancer detection through MRI leads to longer survival. Until we have this evidence, we can’t definitively say whether whole-body MRI is beneficial or not. It simply means we need more appropriate studies.

Do we ever use whole-body MRI in any medical conditions and high-risk patients?

Professional societies like the American Cancer Society (ACS), American College of Radiology (ACR), and European Society of Paediatric Radiology (ESPR) recommend Whole-Body MRI (WB-MRI) for cancer screening in high-risk individuals, such as those with Li-Fraumeni syndrome or BRCA mutations. Li-Fraumeni syndrome is a genetic disorder caused by a mutation, increasing many cancer risks, while BRCA mutations in BRCA1 or BRCA2 raise the likelihood of breast and ovarian cancers and prostate cancer in men.

How sensitive is WB-MRI?

WB-MRI is generally a tool with high sensitivity and can help detect not only cancer but also other conditions such as rheumatological diseases and bone marrow cancers like multiple myeloma. It can also assist in examining areas that other imaging modalities may not detect, such as the back of the brain.

What are the barriers of using WB-MRI as a screening tool?

Whole-body MRI (WB-MRI) as a screening tool faces several barriers. Firstly, the cost is prohibitive; a full-body scan ranges from $2,000 to $2,500, which isn’t covered by insurance, Medicare, or Medicaid, making it accessible only to a few.

Secondly, MRI machines themselves are very expensive.

Additionally, the personnel required to interpret these scans are limited. Radiologists, who undergo extensive training, are in short supply.

Finally, there is the issue of evidence. IF we generate evidence that these screening methods can increase survival through early cancer detection or decrease treatment costs, many insurance companies and governments will be interested in exploring this further and generating more data.

Another issue is the duration of the scan. WB-MRI currently takes about 70 minutes, which is impractical for many patients. Although some companies offer faster scans, the technology still needs significant advancements to become more efficient and widely adopted.

To overcome these challenges, we need advancements in MRI technology and artificial intelligence (AI). AI systems capable of accurately reading WB-MRI scans and identifying suspicious lesions that require a second opinion from radiologists could significantly reduce their workload and cognitive burden.

What are the cons of full body MRI

High rate of false positives and associated anxiety with these results: Whole body MRIs often result in a high rate of false positives. These incidental findings can lead to unnecessary invasive procedures like biopsies. Although the risk of complications from biopsies is low, around 1%, it is still a concern. We lack sufficient data to determine which incidental findings require biopsies because whole-body MRIs haven’t been widely studied as a screening tool. Initially, using this tool might lead to more unnecessary procedures and complications until we gather enough evidence to identify which masses need biopsies and which do not.

Cost and Resource Use: WB-MRI is a costly procedure, and using it in a healthy population without clear indications is not economically viable. The expense of the procedure, along with the additional costs for follow-up tests and treatments due to incidental findings, leads to an inefficient allocation of healthcare resources. According to this paper, the current cost of WB-MRI renders it cost-ineffective. In other words, the expense of performing WB-MRI on the general population does not justify its use.

Where do I stand

I advocate for early cancer screening and better screening and prevention which might include WB-MRI once sufficient evidence is genergated. Although some physicians may argue it could lead to unnecessary investigations and invasive procedures like biopsies, the alternative—missing a cancer diagnosis until it has spread—carries far greater risks and challenges in treatment.

This area remains underexplored. We don’t need to biopsy every lesion detected, nor intervene on every abnormality. A science for following up on WB-MRI findings must be developed. There’s still much we don’t know about how to manage incidental lesions seen on WB-MRI, how often to monitor them, and when intervention is necessary, as the technology is not yet widely used for screening.

Not all lesions on WB-MRI require biopsy. There’s a need to better understand which ones warrant intervention. Suspicious lesions can be monitored with follow-up WB-MRIs at intervals of three, six, and twelve months, allowing us to decide whether to intervene or continue observation. While definitive guidelines are currently lacking, and mistakes will happen as we integrate WB-MRI into cancer screening, our understanding and implementation will improve as we learn which lesions require action.

Lastly, my advocacy extends beyond WB-MRI. I’m committed to supporting any tool that aids in cancer prevention and early screening for the general population. It’s heartbreaking to see young patients, close to my age or even younger, diagnosed with cancer. While I sympathize with anyone losing a family member to cancer, watching young patients suffer is particularly devastating.

Summary

In summary, using whole-body MRI for cancer screening is still in its early stages, and more evidence is needed to prove its effectiveness on a population level. After that, widespread adoption by insurance companies and government agencies will be crucial. However, this requires cheaper MRI machines and improved technology for reading scans without relying solely on radiologists. Additionally, whole-body MRI doesn’t catch all cancers, so a multi-modality screening approach is necessary to focus on prevention rather than treatment.”

Source: Roupen Odabashian/LinkedIn

Dr. Roupen Odabashian is an accomplished Internal Medicine Physician and Hematology/Oncology Fellow with a profound commitment to advancing healthcare through clinical practice, research, and technology. Currently based at the prestigious Karmanos Cancer Institute, Dr. Odabashian is actively involved in pioneering cancer treatments and conducting clinical research.

In addition to his clinical work, Dr. Odabashian is a multifaceted healthcare professional. He hosts podcast at OncoDaily, engaging with leading experts in oncology to share valuable insights with the medical community. Dr. Odabashian also contributes his expertise as an advisor at Spiraldot Health and Mesh AI, supporting innovative ventures in healthcare technology and collaborative scheduling to combat clinician burnout. With his diverse roles and unwavering dedication, Dr. Odabashian exemplifies a commitment to driving positive change in healthcare.